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RAC-Withdrawn Reviews, Explained

James Carroll, for HealthLeaders Media, December 3, 2010

Nothing is ever easy for providers in the ever-fluctuating realm of recovery audit contractors, and the latest spell of operational hiccups heard nationwide is no exception.

No hospital necessarily wants to receive an additional documentation request (ADR) from the RAC, yet when it arrives, it's essentially not surprising. But when a provider receives a follow-up letter from that RAC informing the facility that the claim is closed and the audit has been rescinded, it may throw that hospital for a loop, according to a revenue integrity auditor from a hospital in Region A (DCS).

"We recently received an automated letter notifying us that Medicare made an overpayment related to a CCI edit with an amount and brief description of the claim associated with the overpayment," she says. "When I called [the RAC] to question the letter, a customer service representative told me that they'd rescinded the audit because it was 'outside their audit scope.' "

She continued, "I had to ask for a rescind letter to be sent to me stating this information. We are monitoring the account to assure that money isn't recouped by NGS on day 41, and this has prompted us to do an internal investigation related to this information."

A fellow revenue integrity auditor from a hospital in Region B (CGI), had a similar situation:

"We received an ADR and on the day we were ready to send out the records, we received an additional ADR from CGI stating 'please discard the previous letter,' " she says. "I believe it was a clerical error because they switched those accounts under 'complex reviews being considered' to 'complex reviews approved,' and those under 'complex reviews approved' to 'complex reviews being considered.' "